By C. Aschnu. California Institute of Integral Studies. 2019.
A researcher predicts that smoking cigarettes decreases a person’s sense of smell buy generic sinemet 110mg on-line. A sample of peo- ple who smoke a pack a day produces these scores: 16 14 19 17 16 18 17 15 18 19 12 14 (a) What are H0 and Ha for this study? Foofy studies if hearing an argument in favor of an issue alters participants’ attitudes toward the issue one way or the other discount sinemet 110 mg amex. Poindexter examined the relationship between ratio scores measuring the quality of sneakers worn by volleyball players and their average number of points scored per game cheap sinemet 125 mg overnight delivery. Studying 10 people who owned sneakers of good to excellent quality, he computed r 51. Without further ado, he immediately claimed to have support for the notion that better-quality sneakers are related to better performance on a somewhat consistent basis. A scientist suspects that as a person’s stress level changes, so does the amount of his or her impulse buying. Foofy computes the correlation between an individual’s physical strength and his or her college grade point average. She claims this is a useful tool for predicting which college applicants are likely to succeed academically. We study the influence of wearing uniforms in middle school on attitudes toward achieving good grades. On a national survey, the average attitude score for students who do not wear uniforms is 5 12. A newspaper article claims that the academic rank of a college is negatively related to the rank of its football team. While reading a published research report, you encounter the following statements. For each, identify the N, the procedure performed and the outcome, the relationship, and the type of error possibly being made. What is the design of the study when we compute the z-test and t-test versus when we compute a correlation coefficient? What is the difference between the results of A and B in terms of (a) how signifi- cant they are? For the following, specify which descriptive and inferential procedures should be performed, explain what is being compared, and identify the key to answering the researcher’s question. Should we conclude that performance decreases dur- ing the final hour for all workers? A sports psychologist trained 20 players on this year’s team to visualize each shot beforehand. The formula for a confidence interval for a single 2 is 1©X2 ©X2 2 N 1sX212tcrit2 1 X # # 1sX211tcrit2 1 X s2 5 X N 2 1 where t is the two-tailed value for df 5 N 2 1. Critical values of the Pearson r are found in sX s 5 Table 3 of Appendix C, using df 5 N 2 1, X B N where N is the number of pairs. Critical values of the Spearman rS are found in X 2 tobt 5 Table 4 of Appendix C, using N, the number of sX pairs. As the name implies, this test is simi- lar to the one-sample t-test you saw in Chapter 11, except that a two-sample design requires that we use slightly different formulas. This chapter discusses (1) one version of this t-test, called the independent-samples t-test, and its confidence interval; (2) the other version of this t-test, called the related-samples t-test, and its confidence interval; and (3) procedures for summarizing the results of any two-sample experiment. Actually, N indicates the total number of scores in the study, but with only one condition, N was also the number of scores in the sample. However, now we will be discuss experiments with two conditions, so the lowercase n with a subscript will stand for the number of scores in each sample. Thus, n1 is the number of scores in condition 1, and n2 is the number of scores in condition 2. N is the total number of scores in the experiment, so adding the ns together equals N. The one-sample experiments discussed in previous chapters are not often found in real research, because they require that we know under one condition of the independent variable. Usually, however, researchers explore new behaviors and variables, so they do not know any s beforehand. Instead, the usual approach is to measure a sample of participants under each condition of the independent variable and to use the sample mean to estimate the corresponding population that would be found. Often we test only two conditions, and then our inferential procedures involve two-sample t-tests. Thus, it is important for you to know about these procedures because they apply to a more realistic and common way of conducting experiments that you’ll often encounter. Further, by understanding studies with two conditions, you will understand the more complicated designs and analyses that we’ll discuss in the remaining chapters and that also are common in the literature. Condition 1 produces X1 that represents 1, the we would find if we tested everyone in the population under condition 1. Condition 2 produces X2 that represents 2, the we would find if we tested everyone in the population under condition 2. If each sample mean represents a different population and for each condition, then the experiment has demonstrated a relationship in nature. Even though we may have different sample means, the relationship may not exist in the population. Instead, if we tested the population, we might find the same population of scores under both condi- tions. Then there would be only one value of : Call it 1 or 2, it wouldn’t matter because it’s the same. Therefore, before we make any conclusions about the experiment, we must determine whether the difference between the sample means reflects sampling error. However, we have two differ- ent ways to create the samples, so we have two different versions of the t-test: One is called the independent-samples t-test and the other is called the related-samples t-test. Two samples are independent when we randomly select participants for a sample, without regard to who else has been selected for either sample. Then the scores are independent events, which, as in Chapter 9, means that the probability of a particular score occurring in one sample is not influenced by the scores that occur in the other sample. You can recognize independent samples by the absence of anything fancy when selecting participants, such as creating pairs of participants or repeatedly testing the same participants in both conditions. People who witness a crime or other event may recall the event differently when they are hypnotized. We’ll select two samples of participants who watch a videotape of a supposed robbery. Thus, the conditions of the independent variable are the presence or absence of hypnosis, and the dependent variable is the amount of information correctly recalled. After replacing the Xs with the actual recall scores, we will compute the mean of each condition (each column). If the means differ, we’ll have evidence of a relationship where, as amount of hypnosis changes, recall scores also change. First, as always, we check that the study meets the assumptions of the statistical test.
This book should help the critical care unit clinician readily discern between infectious diseases and the noninfectious disorders that mimic infection discount sinemet 300 mg with mastercard. This is the first and only book that deals solely with infectious diseases in critical care medicine sinemet 110 mg on-line. Rather generic sinemet 125mg free shipping, it focuses on the most common infections likely to present diagnostic or therapeutic difficulties in the critical care setting. The authors have approached their subjects from a clinical perspective and have written in a style useful to clinicians. In addition to its usefulness to critical care intensivists, this book should also be helpful to internists and infectious disease clinicians participating in the care of patients in the critical care unit. Cunha Preface to the Second Edition Infectious diseases continue to represent a major diagnostic and therapeutic challenge in the critical care unit. Infectious diseases maintain their preeminence in the critical care unit setting because of their frequency and importance in the critical unit patient population. Since the first edition of Infectious Diseases in Critical Care Medicine, there have been newly described infectious diseases to be considered in differential diagnosis, and new antimicrobial agents have been added to the therapeutic armamentarium. The second edition of Infectious Diseases in Critical Care Medicine continues the clinical orientation of the first edition. Differential diagnostic considerations in infectious diseases continue to be the central focus of the second edition. For this reason, the differential diagnosis of noninfectious diseases remain an important component of infectious diseases in the second edition. The second edition of Infectious Diseases in Critical Care Medicine emphasizes differential clinical features that enable clinicians to sort out complicated diagnostic problems. Because critical care unit patients often have complicated/interrelated multisystem disorders, subspecialty expertise is essential for optimal patient care. Early utilization of infectious disease consultation is important to assure proper application/interpretation of appropriate laboratory tests and for the selection/optimization of antimicrobial therapy. As important is the optimization of antimicrobial dosing to take into account the antibiotic’s pharmacokinetic and pharmaco- dynamic attributes. The infectious disease clinician, in addition to optimizing dosing considerations is also able to evaluate potential antimicrobial side effects as well as drug– drug interactions, which may affect therapy. Infectious disease consultations can be helpful in differentiating colonization ordinarily not treated from infection that should be treated. Physicians who are not infectious disease clinicians lack the necessary sophistication in clinical infectious disease training, medical microbiology, pharmacokinetics/pharmacodynamics, and diagnostic experience. Physicians in critical care units should rely on infectious disease clinicians as well as other consultants to optimize care these acutely ill patients. The second edition of Infectious Diseases in Critical Care Medicine has been streamlined, maintaining the clinical focus in a more compact volume. The contributors to the book are world-class teacher/clinicians who have in their writings imparted wisdom accrued from years of clinical experience for the benefit of the critical care unit physician and their patients. The second edition of Infectious Diseases in Critical Care Medicine remains the only book dealing with infections in critical care. Cunha Preface to the Third Edition Infectious disease aspects of critical care have changed much since the first edition was published in 1998. Infectious Diseases in Critical Care Medicine (third edition) remains the only book exclusively dedicated to infectious diseases in critical care. Importantly, Infectious Diseases in Critical Care Medicine (third edition) is written from the infectious disease perspective by clinicians for clinicians who deal with infectious diseases in critical care. The infectious disease perspective is vital in the clinical diagnostic approach to noninfectious and infectious disease problems encountered in critical care. The third edition of this book is not only completely updated but includes new topics that have become important in infectious diseases in critical care since the publication of the second edition. The hallmark of clinical excellence in infectious disease consultation is the diagnostic experience and expertise of the infectious disease consultant. The clinical approach should not be to arrive at a diagnosis by ordering a bewildering number of clinically irrelevant tests hoping for clues from abnormal findings. The optimal differential diagnostic approach depends on the infectious disease consultant carefully analyzing the history, physical findings, and pertinent nonspecific laboratory tests in critically ill patients to focus diagnostic efforts. Before a definitive diagnosis is made, the infectious disease consultant’s role as diagnostician is to correctly interpret and correlate nonspecific laboratory tests in the correct clinical context, which should prompt specific laboratory testing to rule in or rule out the most likely diagnostic possibilities. As subspecialist consultants, infectious disease clinicians are excellent diagnos- ticians. For this reason, infectious disease consultation is of vital importance for all but the most straightforward infectious disease problems encountered in critical care. Another distinguishing characteristic of infectious disease clinicians is that they are both diagnostically and therapeutically focused. Many noninfectious disease clinicians often tend to empirically “cover” patients with an excessive number of antibiotics to provide coverage against a wide range of unlikely pathogens. Currently, most of resistance problems in critical care units result from not appreciating the resistance potential of some commonly used antibiotics in many multidrug regimens, such as ciprofloxaxin, imipenem, and ceftazidime. Some contend this approach is defensible because with antibiotic “deescalation” the unnecessary antibiotics can be discontinued subsequently. Unfortunately, except for culture results from blood isolates cultures with skin/soft tissue infections, or cerebrospinal fluid with meningitis, usually there are no subsequent microbiologic data upon which to base antibiotic deescalation, such as nosocomial pneumonia, abscesses, and intra-abdominal/pelvic infec- tions. The preferred infectious disease approach is to base initial empiric therapy or covering the most likely pathogens rather than clinically unlikely pathogens. Should diagnostically valid data become available, a change in antimicrobial therapy may or may not be warranted on the basis of new information. Because infectious disease consultation is so important in the differential diagnostic approach in critical care, this book’s emphasis is on differential diagnosis. If the diagnosis is inaccurate/incorrect, empiric therapy will necessarily be incorrect. To assist those taking care of critically ill patients, chapters on physical exam clues and their mimics, ophthalmologic clues and their mimics in infectious disease, and radiologic clues and their mimics in infectious disease have been included in this edition. In addition, several chapters notably, “Clinical Approach to Fever’’ and ‘‘Fever and Rash,” also emphasize on physical findings. Another important topic has been added on infections related to immunomodulating/ immunosuppressive agents. The widespread introduction of immune modulation therapy has resulted in a recrudescence of many infections due to intracellular pathogens, which are important to recognize in patients receiving these agents. Because miliary tuberculosis is so important and is not an infrequent complication of steroid/immunosuppressive therapy, a chapter on this topic also has been included in the third edition. As mentioned, antibiotic resistance in the critical care unit is a continuing problem with short- and long-term clinical consequences. Currently, methicillin-resistant Staphylococcos aureus and vancomycin-resistant enterococci are the most important gram-positive pathogens in critical care, and a chapter has been added on antibiotic therapy of these pathogens.
The research points to four key issues and chemotherapy buy 125 mg sinemet otc, to mucosal candidiasis in immuno- strategies generic sinemet 110mg on-line. Dental practitioners will re- First cheap sinemet 300mg otc, while the prevalence of dental caries and quire more advanced training in managing age- and periodontal diseases may be changing for the entire pharmaceutical-associated oral problems. The dental profession should consider: Second, if a causal relationship can be established between dental infections and severe, life-threaten- x Exploring, in association with public and private ing medical conditions, primary physicians may health care delivery agencies, plans by which routine become active in diagnosing oral diseases and in primary dental care can be provided to economical- referring their patients for dental care. Third, within the next 10 to 20 years, research x Supporting the concept of medical insurance ben- will lead to new biological therapies for use by den- efits for medically necessary dental care as defined tal practitioners. Thus, the dentist of the future will require a degree of facility with, and an under- The dental profession should consider: standing of, fundamental biology in order to pro- vide optimum patient care as novel treatments x Coordinating programs whereby resources and become available for dental caries, periodontal dis- services are better provided to underserved populations. Fourth, researchers have seen an increasing fre- x Promoting the concept of evidence-based re- quency of significant age-associated oral conditions. Additionally, many dence-based practice of dentistry by requiring out- medical therapies have significant effects on oral tis- comes assessment for dental care. This dental education and dental practice that are leading network will provide current information on the to effective nonsurgical therapies for dental caries knowledge base related to the practice of dentistry. There is a need to evaluate and these guidelines for adoption in the dental school improve the speed and quality of information and tech- curriculum, and by other fields such as general nology transferred from the laboratory and other internal medicine, geriatrics, genetics, and informa- research settings to the public domain. This effort x Creating national clinical research networks that is in danger of losing momentum due to the short- link treatment approaches and treatment outcomes age of individuals who are pursuing careers in aca- in private practice settings. The dental profession exist for medical care, will enable large-scale evalu- should consider taking an active role in developing ations of treatment protocols. This effort should include incentives for those who pur- x Working with local and state dental societies to sue these career choices. Furthermore, the dental strongly support the need to increase resources profession should support the need to increase sup- available for dental research. Workforce for clinical x Promoting the use of laboratory tests to diagnose research will be derived from dental academic insti- oral disease. There is a need to link diag- promoting the development of dentists who wish to nostic tests with therapeutic strategies. Finally, the dental profession should begin to Birek C, Granghi R, McNeil K, Singer D, Ficarro G, Bowden G. New York: Oxford University Press; dental office as a site for screening of systemic diseases 1996. Radioprotection of salivary glands References by amifostine in high-dose radioiodine treatment. Results of a double-blinded, placebo-controlled study in patients with differentiated thyroid cancer. Albrektsson T, Dahl E, Enbom L, Engevall S, Engquist B, Strahlenther Onkol 1999;175:6-12. The development of an index for orthodontic Swedish multicenter study of 8139 consecutively treatment priority. Filler systems based on calci- study with hollow-cylinder and hollow-screw implants. Need for early detection of caries lesions: a United ship of recurrent premalignant head and neck lesions. Carinci F, Pezzetti F, Scapoli L, Martinelli M, Carinci P, Tognon Indianapolis: Indiana University Press; 2000. Association between extent of review of international studies and data regarding the periodontal attachment loss and self-reported history Italian population. Factors contributing to the poorer survival of Ann Arbor: University of Michigan Press; 1999. Development of a classification system for periodontal Centers for Disease Control. Solid free form fabrication methods and ceramic com- Periodontal disease and cardiovascular disease. An overview of the psychological effects of physical American Ceramic Society; 1996. Oral cancer and mouthwash use: eval- Oral and Maxillofacial Surgery Clinics of North uation of the epidemiologic evidence. Non-invasive diagnosis of early lipopolysaccharide on pregnancy outcome in the gold- caries with polarization sensitive optical tomography en hamster. Supernumerary teeth-an diagnosis of oral pemphigoid: a selective review of the overview of classification, diagnosis and management. Genome scan for teratogen-induced cleft- in head and neck cancer: basic science and clinical ing susceptibility loci in the mouse: evidence of both application. Detection of serum antibodies poromandibular disorders: review, criteria, examina- against cytomegalovirus, varicella zoster virus and her- tion, specification, critique. J Craniomandibular pes virus 6 in patients with recurrent aphthous stom- Disorders, Facial and Oral Pain 1992;6:302-55. Infect Dis Clin ed irradiation of head and neck cancer: the potential North Am 1999;13:817-31. Submandibular salivary inflammatory cell infiltration toward alveolar bone in gland transfer prevents radiation-induced xerostomia. Structural basis for the decay of initial activation on osteoclasts, tooth move- fracture toughness of the shell of the conch Strombus ment, and root resorption. Analysis of saliva for periodontal sion by activating matrix metalloproteinase genes. Localization of a gene for prepuber- tial dentures in vitro and in vivo: analysis and model- tal periodontitis to chromosome 11q14 and identifica- ing. A study of saliva and its action on tooth enamel in ref- with cisplatin and 5-fluorouracil in patients with erence to its hardening and softening. Orofacial cleft defects: inference from Brush cytology of herpes simplex virus infection in oral nature and nurture. J Research opportunities and investigator competencies Periodontol Res 1998;33:387-99. Evaluation of components of gingival crevicular Research Training and Career Development to Meet fluid as diagnostic tests. Quantitative measurements of remineralization of incipient Health Dent 1989;49:279-89. Oral clefts and disease progression, mode of invasion, and lymph vitamin supplementation. Cleft Palate The impact of biomolecular medicine and tissue engi- Craniofac J 1999;36:12-26. In vitro bone formation on a bone-like apatite Oral Surg Oral Med Oral Pathol Oral Radiol layer prepared by a biomimetic process on a bioactive Endodont 1997;84:272. Carriage of Candida species and C albicans biotypes Performance and reproducibility of a laser fluores- in patients undergoing chemotherapy or bone marrow cence system for the detection of occlusal caries in transplantation for haematological disease.
Sequencing and teristic of the centromeres of chromosomes; the alternative is genotyping become cheaper every year and new technologies euchromatin purchase 300mg sinemet fast delivery. Some companies claim to be developing methods protein components needed to initiate transcription by binding that would allow a person’s entire genome to be sequenced in a to several components of the complex best 110 mg sinemet. Optimists and pessimists alike dream of the day when everybody’s complete genome Corepressor: A protein that works in the same way as a sequence will be stored in vast databases; they differ only in co-activator order sinemet 125mg without a prescription, but to opposite effect. Since ultimately everybody is related, a practical working deﬁnition is that the parents are second cousins or References closer relatives. Genetic Marker: Any character used to follow a segment of a Autosomal Dominant: The pedigree pattern seen when an chromosome through a pedigree. One can talk Microarray: A postage-stamp size wafer of silicon or glass of the genotype at a single locus, or the overall genotype. It causes loss-of-function mutations to produce daughter cell receives an exact and complete copy of all the dominant conditions. Haplotype: A series of alleles at linked loci on the same physi- Mosaic: An individual who has two or more genetically differ- cal chromosome. A nucle- Isoforms: Different forms of the protein product or mature oside is the same but without the phosphate. X-linked recessive conditions, a woman who has affected or car- Since people have a pair of each autosome, a person has two rier offspring and also affected brothers or maternal uncles. It is the Phenocopy: An individual who has the same phenotype as a logarithm of the odds of linkage versus no linkage. Phenocopies can be a major problem in Lyonisation: An alternative name for X inactivation, a phe- genetic mapping. Phenotype: The observed characteristics of a person (including Marker: See Genetic marker. Meiosis: The specialised cell division that produces sperm and Poly(A) Tail: The string of around 200 consecutive A eggs. Pseudo- genes are quite common in our genome and represent the failed Transcription Factor: A protein that binds the promoters of results of abortive evolutionary experiments. Basal transcription factors are involved in transcription of all genes; tissue-speciﬁc tran- Recessive: A character that is manifest only in the homozygous scription factors cause different cells to express different subsets state and not in heterozygotes. A sibship X–Inactivation: The mysterious process by which every human is a set of sibs. X-Linked Inheritance: X-linked inheritance is seen when a About 1 nucleotide in every 300 is polymorphic. Two separate measures of the hearing important role in the exploration of auditory function. From a clin- threshold, respectively air-conducted (through an earphone or ical point of view, it will transform the classiﬁcation of hearing an insert) or bone-conducted (a vibrator on the forehead or the impairment and the possibilities for new therapeutic approaches. The sive quantity of knowledge on the aetiopathology of hearing ﬁrst show a normal bone-conducted and an elevated air- loss, as the mapping and cloning of genes reveal their functions conducted hearing threshold. The second show equal values of in the inner ear, its structural organisation, and its homeostasis. There are also mixed hearing losses, which Currently, several hundred chromosomal loci have been identi- have elements of both conductive and sensorineural losses. This number has been estimated to represent olds of the two ears, noise masking is needed for the better ear, about half of the genetic changes resulting in hearing impair- in order to ensure that a sensation evoked in the better ear does ments. Thus, genetic factors have to be considered in diagnos- not interfere with the sensation elicited in the worse ear. At A diagnosis of conductive hearing loss made by pure-tone present, clinical audiology has to meet two requirements. A diagnosis of sensorineural system; second, there is a need for new audiological diagnostic hearing loss indicates dysfunction in either the cochlea or the tools sensitive enough to elucidate these changes. This auditory pathway: other investigations are needed to conﬁrm the could help to better deﬁne the phenotype and narrow, to within site of the lesions. Clinical pure-tone audiometry, such as the a reasonable range, the set of genetic investigations necessary. Simulators, Pure-tone hearing-threshold individuals with low levels of vigilance and reduced attention may give unreliable results, i. Three- to ﬁve-year-old children can reliably perform pure-tone audiom- The principal audiometric test entails measuring the auditory etry: Younger children can be examined by special conditioning thresholds for pure tones. In all cases the time-scale and patient age should be speciﬁed Conductive: related to disease or deformity of the outer/middle ears. Audiometrically, there are normal bone-conduction thresholds ( 20dB) and an air-bone gap 15dB averaged over 0. Commonly, the hearing threshold is measured at frequen- cies separated by octave intervals, from 0. Indeed, as the hearing thresholds and auditory threshold values of contiguous frequencies are correlated, the more the frequencies recorded, the less the probability of damage the errors associated with a single-frequency threshold mea- surement. The measurement error for air-conduction testing is External and middle ear usually estimated within 5 dB, and it is about twice that ﬁgure for bone-conduction testing. These errors mainly originate from A variety of genetic syndromes can affect the anatomy of these the transducers’ incorrect positioning as well as subject-related structures. Such anom- The accuracy of the pure-tone hearing threshold is crucial alies range from simple stenosis of the external meatus to total in deﬁning any progression of the hearing impairment (1). Two extreme pathological pictures may be taken as a ref- the gap-junction system, the ionic-transport channels, the synaptic erence to predict the pure-tone threshold: (i) Simple atresia of organisation, as well as some components of extracellular matrix the external meatus causes a 30 to 35 dB conductive hearing (5,6). Such alterations may affect auditory function in different impairment due to the attenuation of the sounds directed to the ways, independently of the anatomical loss of hair cells. This condition is not reﬂected in the vary in respect to the anatomical structures involved and their audiogram, since frequencies that should be processed by the consequence on auditory function (Fig. Finally, another Inner ear limitation of pure-tone measurements is that the typical “auditory Inner ear lesions resulting in a sensorineural hearing loss show residue” observable at low frequencies in profound hearing loss is a moderate relationship with the pure-tone threshold. An ele- difﬁcult to attribute unquestionably to an auditory rather than a vated threshold at high frequencies indicates damage to the tactile sensation (Fig. An elevated threshold for low fre- quencies suggests damage of the apical portion. Schuknecht’s Cochlear nerve (4) studies on the comparison of audiograms to cochlear histol- ogy (“cochleograms”) corroborates such a relationship. A fur- Pure-tone thresholds are relatively resistant to lesions involving ther distinction involves the degree of hearing loss. A complete humans, the vestibular Schwannomas represent the most com- loss of inner hair cells should cause a profound hearing impair- mon clinical cause of cochlear nerve lesions. In practice, the lesions with this pathology, about 80% show a hearing impairment, usually involve both the outer and the inner hair cells, with the although the amount of hearing loss correlates only poorly with proportions depending on the causative factor. For those cases with a high-frequency hearing these observations, other conditions have to be considered, in loss, a mechanism was suggested in which the most external which the audiogram–histology relationship may break down. There are, however, mal in its microscopic structure, but the biochemical–metabolic many exceptions to this picture.
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